From January 1, 2021, Dupigent® Patients with severe atopic dermatitis administering 300mg can receive special benefits for calculating health insurance.
On December 24, the Ministry of Health and Welfare announced some amendments to the notification of the’Standards for Calculation of Self-Payment Charges’, which applies special calculation cases to severe atopic dermatitis.
When the calculation special case is applied, the co-payment for medical care benefits for patients with severe atopic dermatitis is reduced from 30 to 60% to 10%.
For reference, atopic dermatitis was not subject to special calculation because there is no distinction between mild and severe, but a new disease code for severe atopic dermatitis was established in July 2020.
The criteria for applying special cases for calculating severe atopic dermatitis are as follows.
· Diagnosis by a dermatologist, an allergic physician, a pediatrician and a pediatric allergic respiratory specialist is necessary to receive the special calculation
· [신규 등록 환자]
-In order to apply the calculation special case as a new atopic dermatitis patient, a patient with chronic severe atopic dermatitis whose symptoms last for 3 years or more must meet all of the following criteria:
-▲Eczema Severity Assessment Index (EASI) was 23 or higher before registration of the calculation special case. Cyclosporine or methotrexate) has been administered for more than 3 months, but there is no response, such as a reduction of EASI of 50% or more, or cannot be used due to side effects, etc.
-At this time, the history of administration of local treatments and systemic immunosuppressants must be within 6 months from the date of registration of special calculation.
· [기존 듀피젠트® 투여 환자]
-Special calculation is also applied to patients with severe atopic dermatitis who are already receiving treatment with the biological agent Dupigent® through health insurance benefits.
-However, if you are receiving treatment at 100% of your own expense because it does not meet the insurance recognition criteria, it is not subject to the special calculation.
-This standard is limited to applications made by June 30, within 6 months from the effective date of the system.
The benefits of applying the calculation exception are as follows.
Regardless of whether you visit a senior general hospital, general hospital, hospital or clinic, the co-payment is reduced to 10% from the medical care benefit cost for severe atopic dermatitis treatment.
According to the application of the calculation special case, patients who receive Dupixent® 300mg through salary pay 71,000 won per dose.
Due to the application of the special calculation, the annual treatment cost of Dupigent is expected to be reduced to 2 million won, which is half of the price of 5.82 million won when applying the out-of-pocket maximum in 2020.
Regarding the contents of the announcement from the Ministry of Health and Welfare on December 24, refer to the following.
Ministry of Health and Welfare No. 2020-308 “Standards for Calculation of Self-Payment” partially revised (2020/12/24)